Q: Why can’t transgender people just be gay? / Isn’t transition homophobic because it forces gay men and lesbians to become straight women and straight men?

Being gay is about who you love. Being transgender is about who you are.

Many people wrongly believe that transgender women are gay men who are so feminine that they feel like women, or who transition out of self-hatred for their homosexuality, or who decide to become women to attract straight men (and vice versa for lesbians). This is untrue, not least because many trans people go from being perceived as straight to being perceived as gay or lesbian. Many trans people first experience gender dysphoria in childhood, long before puberty or any sexual feelings.

Like everyone else, transgender people can be straight, gay, bisexual, asexual, or something else. Surveys show that about a quarter to a third of transgender people are gay or lesbian (with respect to their gender identity rather than assigned sex); a similar number are straight, and another third bisexual or other.

Q: Why can’t transgender people just be feminine men or masculine women? / Doesn’t this reinforce sexist stereotypes about what men and women ‘should’ be like?

Another common misconception conflates gender expression (being masculine or feminine) with gender identity (being a man or woman). People point out that just because a girl might enjoy stereotypically male activities like sports, it doesn’t mean she’s really a boy.

This is true. Many women are not feminine, and enjoy and excel in many things that society typically labels ‘male’. However, they still see themselves as women and wish to be perceived by others as such. When people refer to women, they feel included in that reference. When they think of the opposite sex, they think of men. When they are attracted to someone, they think about being their wife or girlfriend, not husband or boyfriend. When they think of their future, they see themselves as old women, not old men.

The same is true for transgender women. The desire is to be seen as a woman and/or have a female body, not to be feminine. Being a feminine man would thus do absolutely nothing to address the problem – all the more so if they would feel most right as a masculine woman.

Even if it were the case that all trans women were feminine and all trans men masculine, it would still not be fair to place more blame on trans people for asserting their gender identity. For instance, it would be a double standard to criticise a trans woman for wearing a dress and thus playing into female stereotypes, while not criticising a cisgender woman for doing the same.

Q: Is being transgender a mental illness?

No. While gender dysphoria is considered a mental illness, this refers to the distress experienced from being transgender, and not the state of being transgender itself. Medical authorities recommend transitioning as the appropriate treatment for gender dysphoria. Right now, it is the only solution that has proven to be effective in resolving (rather than suppressing) the condition.

Prolonged untreated gender dysphoria does correlate highly with increased mental health problems that may not fully resolve even after transition, such that many transgender people do suffer from mental illness.

However, being transgender on its own does not fulfill the psychiatric definition of mental illness and is not considered as such. Many transitioned trans people have similar states of mental health as non-trans people of the same gender, with outcomes strongly affected by other factors such as poverty, employment, experience of abuse, and level of social acceptance.

Mental health outcomes have been very positive – outstripping the general population – in transgender people who transition early in supportive environments. Significant positive effects on mental health are associated with transition in general.

Q: How is being transgender different from believing you’re a duck/attack helicopter/Lee Kuan Yew? Isn’t that delusional?

Someone who truly believes that they are a duck (and isn’t, in fact, a duck) would often fit the criteria of a diagnosable mental illness such as schizophrenia. They would experience other observable symptoms of the illness such as hallucinations or hearing voices, indicating a dissociation from reality. Such a person would likely find it difficult to function on a day-to-day basis. Their delusion involves things that are demonstrably false – for instance that they have feathers and a beak.

There are cases where schizophrenic patients experience delusions of being the other sex. However, this manifests in the same way they may believe themselves to be a duck, and does not resemble gender dysphoria in transgender people. For instance, a schizophrenic man may be convinced that he is the Queen of England with the body to match, and remain oblivious to all evidence otherwise.

Whereas a transgender woman is perfectly aware that her body is what’s typical for men, not women. When she says that she’s a woman, she is speaking about her internal sense of self, not what body parts she has. She is not deluded about her physical state or how other people view her (as male), and it’s precisely that awareness and lack of delusion that leads to her distress and desire to transition.

However, it is also possible for delusional disorder to manifest in an otherwise sane and normally-functioning individual, such as where someone may be convinced that the government is spying on them (assuming they are not in fact doing so). We grant that it may be possible for a cisgender person to be genuinely deluded (not merely mistaken) about their gender identity and fully believe they are transgender when they are not, and vice versa. However, given that it is not currently possible to identify such cases, and that their experience of dysphoria may be identical to that experienced by transgender people, transition would be the practical course of action if they meet the guidelines for requiring it. If treatment produces negative effects (such as inducing gender dysphoria in the other direction), it can easily be halted; whereas if this alleviates their distress and improves their daily function and well-being, it would arguably be in their best interests to continue.

The same would hold true if in fact all transgender people were deluded about being trans. Regardless of the cause, transition has proven to be the only effective cure for gender dysphoria. The emphasis should always be on acknowledging a person’s pain and seeking the best way to address it, rather than to dismiss their pain or assume it’s not true.

Q: How can I know if I am transgender?

There is no objective test that can prove your gender identity one way or another. However, if you are feeling uncomfortable with your sex, there are some questions that might help guide you along in determining what’s behind these feelings, and to figure out your identity and what steps (if any) you should take to transition.

Occasionally, a desire to be another sex may sometimes have explanations other than being trans, where transitioning is likely to worsen rather than improve the situation. Note that these are just guidelines, not hard and fast rules. There are no right answers, and people who are trans may not always give the same answers, but these can act as a starting point.

Do you feel pressured to do certain things or behave a certain way because of your sex? If you were given complete freedom to live life the you want, as a member of your sex, would the discomfort go away? Say you’re often bullied for acting too feminine for a man and made to feel like you can never be good enough. In a world where feminine men were celebrated and you were allowed to be as feminine as you liked, and your parents were proud of you just the way you are, would you still be uncomfortable being seen as a man? What about in a world where the majority of men were stereotypically feminine, and being masculine was a rarity? If you think you are transgender solely because you enjoy things that are atypical for your sex, you are probably not transgender, but a masculine woman or feminine man. Focus instead on finding ways to explore that side of yourself, or ways to gain the freedom to do so if you find yourself restricted in that area, and see if that solves your discomfort.

Does the thought of not being transgender upset you or provide relief? Why, or why not?

If you feel restricted and frustrated by female gender roles and having to deal with sexism, being talked down to, sexualised, considered inferior or otherwise mistreated due to your sex, does your pain stem primarily from that sexism or also from being female? If full gender equality were to finally be achieved and you no longer had to deal with any sexism, would you then be content living as a woman? What about in a world where gender roles and stereotypes were flipped and it is men who suffer through all that? In such a scenario, would you still wish to be male? Would you merely tolerate being female for the benefits? Or would you then fully enjoy being female?Some girls or women who have experienced sexual abuse may view transitioning to a male (or neutered) body as one way to escape further abuse, or to separate themselves from their past. They associate being male with being safe and protected from further harm, and it is this need for safety that drives their desire to transition. Some trans men may also harbour similar feelings, the difference being that the desire to be male exists independent of this fear (in as much as it is possible to discern).Consider that transgender people as a whole are much more at risk of sexual assault than the general population, and while transitioning may reduce the risk for trans men, it will not wholly eliminate it and in certain situations may make it worse. If you are someone in this situation, you may want to consider your reactions to having to choose between two options: one in which you are female but assured a safe life free from sexual or emotional abuse, and one in which you are male but subject to sexual abuse. If this causes your desire to be male to disappear completely, trauma is likely to be a major component of your dysphoria, and transition may not solve your distress. (It may in fact worsen it, if you start recognising your body as male and fearing it as well, while losing access to female spaces and being put in more situations where you need to be around strange men.) Whereas if it reduces but does not eliminate that desire, there may be more going on. As always, there are exceptions, for instance a trans man with a history of sexual trauma whose aversion to additional abuse overrides any dysphoria he feels.

All teenagers go through a period of identity formation and trying to work out their place in the world. This may sometimes extend to gender. If you are a pre-teen or teenager whose feelings about your gender are more questioning in nature than distressing, consider giving yourself time to mature and figure out who you are before making any big decisions. Teenagers may grapple with what it means to have a female body in a society that often sexualises and demeans such bodies, or a male body in a society that places certain expectations (sex, violence, NS, emotional deadness) upon such bodies. If, however, you experience distress about your sex that seems unusual in scope and degree compared to what your peers are going through, you may wish to look further into this with a trusted counsellor.

As a thought experiment, invent a attractive fictional character of your assigned sex with the personality traits, interests, talents, relationships and social reputation that you would personally love to have. How would you feel if you were that person? Would everything be perfect, or would your sex still bother you?

If you are uncomfortable with the sexed characteristics of your body (chest, genitals, etc), does this discomfort stem from how people react to them, what they symbolise, and how they indicate your belonging to a particular sex, or from the material fact of their existence? If people no longer reacted that way, and the symbolism changed, or even if they were instead an indication that you were of the other sex, would you still be uncomfortable with those characteristics? e.g. if most women had penises and it was known as a female rather than male organ, would yours still feel wrong? (Or, would you still want to obtain one?)

If you are dealing with homophobia, either from others or yourself, and you feel that you cannot freely love the people you love, or have your relationships deemed as valued and legitimate as that of straight people, would your pain still exist in a world where homosexual relationships were valued and celebrated as much as heterosexual ones? If you could freely find a partner and love them, with the full blessings and support of your religion, family and society, would you still be uncomfortable with your sex?

If you desire to transition just so that somebody will love you, please don’t. This may take the form of wishing to please a parent who wanted a son or daughter and scorns you for being the ‘wrong’ gender, or a crush who isn’t attracted to people of your sex, or a partner whose family will never accept their child in a homosexual relationship. People change, and attitudes change, but transition is a very personal thing that will have major and permanent impacts on the rest of your life. If you were not transgender to begin with, doing so would also induce the same gender dysphoria that causes transgender people so much distress. Never transition for somebody else.

In rare cases, people with OCD may fixate on the (false) idea that they are transgender and should transition. If you have a history of OCD (diagnosed or suspected) and the thought of transitioning fills you with immense fear because you like your body and gender and don’t want to be another sex (but are afraid you secretly want to), and these thoughts persistently intrude and interrupt your daily functioning, you are unlikely to be transgender. Please seek help from a professional counsellor or psychiatrist trained to deal with OCD. (Likewise if you are a trans person with OCD who is plagued with paranoid thoughts and the immense fear that you might not be trans after all and might be making a big mistake, even if you’re wrecked with dysphoria and desperately want to be the other sex.)

If you were given a magic button that could instantly and painlessly change your body to the one of your desired sex, and nobody would judge you for it and there would be no awkwardness to deal with, would you press that button? Would you stay that way?

When you hear the phrase ‘opposite sex’, do you think of men or women? How do you feel about your answer? Does it feel normal, or does it feel wrong?

If you were all alone on a desert island with nobody to see or judge you, would you still be uncomfortable with your sex?

If you were given the chance to create an ideal, permanent human body for yourself, what sex would it be?

When you imagine yourself in your ideal romantic relationship, what sex are you? Are you a straight or gay couple? Or something else altogether?

When you imagine yourself as an old person having lived a long and contented life, what sex is that person?

While gender dysphoria and sex dysphoria often come together, this is not always the case for everyone. Some people may be happy socially transitioning, but experience no dysphoria with their body and thus not seek to medically transition. They might be happy living their lives as a woman with a typically male body or vice versa, where any distress comes only from how society reacts rather than their bodies. Others may be relatively content living as their assigned gender but experience a great sense of wrongness over the sexed characteristics of their body. They might thus seek medical transition, where social transition then naturally occurs as they start looking more like and being recognised as that sex. (In rare cases, this may induce gender dysphoria, and lead to, say, somebody born male realising that he feels most at ease living as a man but with a typically female body.)

Yet other people are non-binary, and are most comfortable with a body and/or gender expression that is not strictly male nor female but both, neither, or that changes over time.

Yet others come to realise that their gender dysphoria was a by-product of other issues (such as those laid out in the list above), and that transitioning would not be appropriate for them.

Some people who do experience body dysphoria may also find it to be manageable, and decide not to seek medical intervention. They may also choose to pursue some treatment (e.g. hormone therapy) but not others.

Q: If I experience gender dysphoria, does that mean I have to transition?

No. Whether or not you transition is ultimately a very personal decision that should not be made lightly, and is something you’ll have to decide for yourself. Transition may be liberating, but can also often be painful and come with a high cost – not just financially but in terms of your safety, relationships, career, and so on.

Don’t rush into anything, but give yourself time to think this through. Many transgender people spend years grappling with our identity and whether or not to transition (and to what degree) before taking any action. Some people change their minds multiple times before coming to a decision. That’s normal, because transitioning can be scary, and is often a last resort for many people.

Some transgender people find that they are eventually able to accept living as their assigned gender, and even find happiness over time. Others find this impossible after years of trying. Others find ways to compromise – such as by dressing more masculine or feminine, or by adopting male/female/unisex nicknames. Yet others find that it helps to privately affirm their identity as men, women or other but continue living outwardly as their assigned gender: for example, a transgender woman who acknowledges that she is a woman, in order to have that internal peace of mind and perhaps even to be recognised as a woman by close friends and family, albeit one who has made the decision to continue living as a man with a typically male body, because that’s what is best for her specific situation.

There is no one-size-fits-all solution, and how you choose to resolve or live with your gender dysphoria will depend on your specific case.

When it comes to medical transition in particular, here are some questions you might want to ask to figure out if it is right for you:

Does my discomfort with my body stem more from social ideals of what men and women ‘should’ look like, or a more fundamental disconnect? i.e. if nobody could tell I was trans and found me conventionally attractive for my gender, just as I am now, would the discomfort still be there?

Is my body dysphoria bad enough to significantly interfere with my day to day life and normal functioning?

Am I willing and able to be on lifelong hormone therapy?

Do I have any medical conditions that may make HRT or surgery risky? (please consult a doctor.)

Q: Do all transgender people take hormones or have surgery?

No. Some are content dressing and living as the gender they identify as. For those with severe body dysphoria, medical intervention such as hormone therapy or sexual reassignment surgery may be required for them to feel comfortable in their bodies.

Q: How long does hormone therapy last?

Lifelong hormone replacement therapy (HRT) is needed to maintain the body’s masculinisation or feminisation. If the gonads (ovaries or testes) have been removed, it becomes medically necessary for health. However, some trans people choose to only go on HRT for a while to achieve certain permanent changes (lower voice, breast growth, etc) and cease it after, whereupon some changes will reverse.

Q: How does someone become transgender?

The evidence currently points towards a biological basis, in particular the role of prenatal sex hormones[1]. Some such examples are:

A correlation between 2D:4D finger digit ratios (the length of one’s index finger to that of one’s ring finger) – which is an indicator of prenatal testosterone levels – and gender identity. One study found that transgender men on average have significantly more masculine digit ratios compared to both control males and control females, indicating anomalously high testosterone exposure in the womb.[2]

In a study of women who had been exposed to a now-banned estrogenic drug (DES) during pregnancy, almost a third of their male children were gender dysphoric and identified as female or non-binary. This is a rate of a hundred times the natural occurrence of transsexualism and is too high to be coincidental.[3]

Transgender identities may also be a natural part of human sexual diversity.

A typical man has XY chromosomes, penis and testes, a deep voice, facial and body hair, and so on. Others have less masculine bodies – low testosterone levels, higher voices, sparse facial or body hair, but still think of themselves as men. A small minority are mildly intersex: they might have micropenises, be unable to urinate standing up, have feminine skeletal structures – but still see themselves as men. A smaller minority are severely intersex, including those with XXY chromosomes (Klinefelter’s Syndrome), those born without penises, those who have uteruses, ovaries or vaginas (sometimes in addition to male organs), but also still consider themselves men, even though some of these might have been raised as girls and been unaware of their intersex status until adulthood.

Even further along that spectrum, an even smaller minority of men have XX chromosomes, uteruses, ovaries, vaginas, and all those other typically-female sexual characteristics, but, like all those before them on that spectrum, also consider themselves men and might desire more masculine bodies. These are transgender men.

It would be stranger if that group did not exist and the spectrum ended abruptly. Biology would thus seem to predict the existence of transgender people – people who have most or all the physical characteristics typical of the other sex – given that human bodies have been discovered to exist everywhere else on the sexual continuum in huge variation.

Another theory has to do with how humans form in-group / out-group associations when very young. A few people may for some reason form the ‘wrong’ associations and be psychologically imprinted with a cross-sex gender identity – i.e. whatever neuropsychological process happens to make a cisgender girl identify herself as a girl is set in motion in the brain of a male child, resulting in a transgender girl who ‘feels’ like a girl in the exact same way other girls do, despite her body. This is also likely influenced by biological factors that may predispose some people towards being transgender.

Whatever the cause may be, it is likely to be complex and not easily ascribed solely to biological, psychological or social influence. Within the trans community itself, there is a lot of variation in how those identities manifest, suggesting that different combinations of causes may be at play in each individual. One trans person may have a strong sense of their body being the wrong sex, another may be fine with their body but have a strong sense of being another gender, and yet another may not feel right as either a man or woman.

About 0.3% of the population or more is transgender, and trans people have existed across all cultures throughout history. Estimations of prevalence have increased of late as more people find it safer to come out and transition.

Q: Why are so many transgender people over-the-top feminine or masculine?

Transgender women in particular are often criticised for what is perceived as portraying a caricature of womanhood in going overboard with feminine mannerisms, makeup and dress.

There are a few reasons for this. Firstly, for those who have not undergone any medical intervention, dress and behaviour are the only ways they have to express their identities as women. If a trans woman who has not medically transitioned goes around with short hair and in unisex clothes, acting in a neutral or masculine manner, everyone would naturally perceive her as a man. Dressing up and being exaggeratedly feminine is thus one major way of correcting that assumption. This is most prevalent when they first come out; as they progress in medical transition and start to be consistently read as women no matter how they dress, most eventually get comfortable with toning it down to what feels more natural.

Secondly, trans women are under immense pressure from society and healthcare providers to ‘prove’ that they are women. A trans woman who doesn’t present herself in an overtly feminine manner thus runs the risk of not being taken seriously. There are multiple stories of trans women being denied transition by their doctors because they turned up for an appointment in jeans and T-shirt, and were deemed to not be serious enough about transition until they turned up in heavy makeup and flowy dresses.

Thirdly, there’s the freedom that comes with finally being able to express a long-repressed identity. A trans woman who has had to repress her feminine side for years will naturally go slightly wild when she finally has the freedom to do all the feminine things she always wanted. Early transition is also a time of discovering oneself and the kind of man or woman you are going to be, which may mean lots of experimenting with different clothing styles and mannerisms. A similar process happens to all teenagers, but stands out more in transgender people who transition in adulthood, by which time most other people have outgrown that phase and have since settled in their identities.

Q: What about transracial people?

The term ‘transracial’ originally applied to children adopted by parents of a different race, which may affect their sense of racial identity and belonging. The term has since come to refer also to people like Rachel Dolezal who claim to identify as a different race than that they were born. People then ask why such identities are invalid if transgender identities are considered valid.

Most of the time, people who claim to be transracial are unable to explain what it means to ‘be’ that race without resorting to stereotypes that are often racist and closely associated with class status. e.g. people in the West tend to describe being rich, educated and articulate as ‘acting white’, which implies pretty bad things about what non-white people are supposed to be. Or a non-Asian person may talk about how they love Asian culture and thus consider themselves Asian.

But racial identity is not so much culture or interests (or biology) as how you are perceived and treated by the world because of how you look. For example, there are rare cases of biracial twins who look like different races, and effectively are different races despite having very similar genetics and upbringing. How they interact with the world and how the world responds to each of them would be very different.

Race itself is a social construct that changes over time, subject to political influences. In the past, Irish and Italians were not considered white, but now they are; in America, there was a time when anyone with even 1/16th black ancestry was considered black, even if today we would consider them white; Indians are technically Caucasian, but are presently categorised as Asian; and so on. This further muddies what it means to identify as a different race, given that in a different time, you might very well have been considered that race. Within each race there is already so much physical variation, where in fact intra-racial populations exhibit a much greater genetic diversity among themselves than between different races.

Likewise with gender, simply having masculine or feminine traits isn’t what makes someone a man or woman, and it’s a common misconception that that’s what transgender people are. Being transgender isn’t about being a masculine woman or feminine man who might as well be the other gender. It’s about core gender identity that somehow formed at odds with anatomy, often very early in life (though it may not be recognised till much later) and which affects every part of how that person views, relates and interacts to the world, as well as the socialisation they absorb. This indelibly shapes the person that they are, as it does with children adopted by different-race parents, but not with people who decide they are a particular race because they share stereotypical traits with that race (which may very well not apply in a different country).

In some occasions, it may be possible for people to develop a genuine transracial identity, in the sense of genuinely seeing themselves as that race. This happens most commonly for those who are racially-mixed but identify wholly as just one of those races; in rare circumstances, it could conceivably happen with people who have no biological links to that race. This would however be a psychological identity-formation process, rather than a biological one.

Q: People with Body Dysmorphic Disorder (or anorexia) are treated with psychiatric help, not surgery. Shouldn’t transgender people also be treated with therapy instead of allowed to change their bodies?

While the two conditions may seem similar on the surface, they have different causes, different manifestations, and more importantly different treatments that have been reliably proven to work.

Body Dysmorphic Disorder (BDD) is a condition in which a person comes obsessed with imagined defects in their body. Someone with BDD might wrongly perceive their normal-sized nose as gigantic, for example. After they’ve undergone surgery to make it tiny, they may still be distressed at the misperception that it is huge. This is a psychiatric issue, and more surgery would not fix the problem. Anorexia is a similar condition where a thin or average-sized person may wrongly believe they are fat, and losing weight does not ease the distress.

Whereas a transgender man might want to remove his breasts, and after surgery successfully gives him a flat chest, he doesn’t continue thinking he has huge breasts. If he did, that would be a manifestation of BDD.

Individuals with BDD respond successfully to psychiatric treatment and medication. Whereas when psychiatric treatment is attempted for transgender individuals, the distress often increases and does not go away. Instead, allowing hormonal therapy and surgery as desired does successfully provide that relief.

问：有人后悔性别转换吗？

Chinese translation by Shou Chenyan from the University Scholars’ Programme, NUS

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